Abstract
PurposeTo evaluate the feasibility of triple rule out computed tomography (TRO-CT) in an emergency radiology workflow by comparing the diagnostic performance of cardiovascular and general radiologists in the interpretation of emergency TRO-CT studies in patients with acute and atypical chest pain.MethodsBetween July 2017 and December 2019, 350 adult patients underwent TRO-CT studies for the assessment of atypical chest pain. Three radiologists with different fields and years of expertise (a cardioradiologist—CR, an emergency senior radiologist—SER, and an emergency junior radiologist—JER) retrospectively and independently reviewed all TRO-CT studies, by trans-axial and multiplanar reconstruction only. Concordance rates were then calculated using as reference blinded results from a different senior cardioradiologist, who previously evaluated studies using all available analysis software.ResultsConcordance rate was 100% for acute aortic syndrome (AAS) and pulmonary embolism (PE). About coronary stenosis (CS) for non-obstructive (<50%), CS concordance rates were 97.98%, 90.91%, and 97.18%, respectively, for CR, SER, and JER; for obstructive CS (>50%), concordance rates were respectively 88%, 85.7%, and 71.43%. Moreover, it was globally observed a better performance in the evaluation of last half of examinations compared with the first one.ConclusionsOur study confirm the feasibility of the TRO-CT even in an Emergency Radiology department that cannot rely on a 24/7 availability of a dedicated skilled cardiovascular radiologist. The “undedicated” radiologists could exclude with good diagnostic accuracy the presence of obstructive stenosis, those with a clinical impact on patient management, without needing time-consuming software and/or reconstructions.
Highlights
Non-traumatic chest pain is one of the most common complaints in emergency departments (ED), and its evaluation is a very complex issue for ED physicians [1].Triple rule out computed tomography (TRO-CT) is an electrocardiography (ECG)-gated examination that noninvasively evaluates the coronary circulation and simultaneouslyTRO-CT can accurately rule out acute coronary syndrome (ACS) with excellent negative predictive values [4] in the majority of patients with acute chest pain and could identify those with significant coronary artery stenosis
The purpose of our study was to evaluate the feasibility of TRO-CT in an emergency radiology setting comparing the diagnostic performance of cardiovascular and general radiologists in the interpretation of TRO-CT studies in patients with acute and atypical chest pain
Among 350 TRO-CT scans, 310 (88.7%) were performed with retrospective ECG-gating with an average dose of 11.79 mSv, while the remaining 40 TRO-CT (11.3% of patients) were acquired with prospective ECG-triggering with an average dose of 6.13 mSv
Summary
Non-traumatic chest pain is one of the most common complaints in emergency departments (ED), and its evaluation is a very complex issue for ED physicians [1].Triple rule out computed tomography (TRO-CT) is an electrocardiography (ECG)-gated examination that noninvasively evaluates the coronary circulation and simultaneouslyTRO-CT can accurately rule out ACS with excellent negative predictive values [4] in the majority of patients with acute chest pain and could identify those with significant coronary artery stenosis. Non-traumatic chest pain is one of the most common complaints in emergency departments (ED), and its evaluation is a very complex issue for ED physicians [1]. Anatomic imaging of the whole chest with TRO-CT can detect non-coronary causes of acute chest pain, helping emergency department physicians to rapidly direct patients to the most appropriate in- or out-patient treatment [5]. TROCT requires time-consuming imaging interpretation by subspecialist cardiovascular radiologists and it is still controversial if their assistance is required to perform TRO-CT in an emergency setting [9]. The purpose of our study was to evaluate the feasibility of TRO-CT in an emergency radiology setting comparing the diagnostic performance of cardiovascular and general radiologists in the interpretation of TRO-CT studies in patients with acute and atypical chest pain
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